I have a customer that has claims being rejected by Medicare payer in IDAHO because LOOP 1000A NM109 contains the Facility ETIN # instead of the assigned Medicare #.
The code in gen_x12_837.inc.php for that loop just reads from the facility record for each claim set. Availty says that number is Payer specific.
Any suggestion how the system should be modified to check if the payer (insurnace_company table) has a submitterID that should overide the ETIN from the facility record? There is no field for that in that table and the insurance_numbers table is provider specific not Billing facility.
I anyone else getting claim rejects because of this issue?
Thanks, that was helpful to show that this is a common issue, but I don’t want to do a hack job for a single customer. I’m looking for suggestions on the best way to implement this for general use.
Here’s what I think:
Assumption: This is Payer specific
The simple thing to do is to add a field to the insurance_company table to include an X12 Payor ID override for loop 1000A (Facility ETIN)
The same problem drove Jit Chawla nuts. Why else ask for professional help no less? David Martell was having a hard time until Art Eaton did some serious brainstorming.
Easiest solution is Office Ally if a practice has all the insurers on the Payor List. Enrollment (paperwork) was required only for Medicare & Blue Shield. With the exception of the X12 info, which they entered for us via LogMeIN, everything else was DIY.
David switched from Office Ally to Availity. The rest of us are pleased with Office Ally. J. Defoe has posted that Availity started to charge for a bunch of local Florida carriers. CVerk used Office Ally for more than 3 years and I, 2 years; never a bill.
We use only Office Ally for all our e-claims. For the rare insurer that accepts only paper, we mail those ourselves. Despite being on the other coast the Payor List was more extensive for our needs than Availity.
No reason for a clearinghouse to put people through such grief. According to their website, a consortium was established by the Blues from the South to facilitate e-claims. Could have fooled me.